Patient guide · Ophthalmology
Orthoptic consultation, specialist assessment of eye movement, alignment and binocular vision.
An orthoptist assesses eye movement, alignment, binocular vision and squint (strabismus) — for children with amblyopia and adult double vision, from paediatric squint through to thyroid eye disease and post-stroke diplopia.
Key facts
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Definition
Specialist assessment of eye movement, alignment and binocular vision.
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Delivered by
Orthoptist-led, linked to consultant ophthalmology.
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Diagnoses
Amblyopia, strabismus, diplopia.
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Management
Patching, prism, exercises or surgery planning.
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Complements
OCT and neurology imaging.
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Turnaround
Same-day report and plan.
What to expect
From referral to plan — what happens, in order.
A first orthoptic assessment usually takes 45–60 minutes and produces a written report and management plan the same day.
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Referral or self-book
Direct booking or referral from GP, optometrist or paediatrician.
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Visual acuity
Age-appropriate letter, picture or matching chart testing.
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Cover test and alignment
Cover/uncover and alternating cover tests to detect manifest and latent squint.
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Ocular motility
Eye movements through nine positions of gaze, looking for restriction or overaction.
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Stereopsis testing
Frisby, TNO or Titmus stereo tests to quantify binocular depth perception.
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Prism cover measurement
Prism cover test to quantify the angle of squint at distance and near.
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Written report and plan
A same-day written report with a clear management plan and onward referral if needed.
What it shows
When an orthoptic consultation is the right assessment.
Orthoptic clinic answers a specific question — how the eyes move, align and work together — and identifies whether the underlying cause is developmental, muscular or neurological.
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Amblyopia (lazy eye)
Reduced vision in one eye that developed in childhood, often treatable if caught early.
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Squint (strabismus)
Manifest misalignment — esotropia, exotropia, hyper/hypotropia — in children and adults.
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Diplopia (double vision)
Binocular or monocular double vision, quantified and characterised.
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Cranial nerve palsy
Third, fourth or sixth nerve palsy causing acquired diplopia.
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Thyroid eye disease motility restriction
Restrictive myopathy from thyroid orbitopathy, tracked over time.
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Convergence insufficiency
Difficulty converging for near work, often causing headaches and blurred reading.
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Post-stroke visual disturbance
Diplopia, field defect and gaze palsy after cerebrovascular events.
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Red flag: acute-onset diplopia with pupillary involvement — urgent neurology (third nerve palsy)
A pupil-involving third nerve palsy is a neurosurgical emergency until aneurysm is excluded.
Treatment options
What the plan can look like.
Management is stepwise — the least-invasive option that gives durable single vision, with surgery reserved for measured, stable angles.
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Patching for amblyopia
Occlusion therapy of the dominant eye to drive vision in the amblyopic eye.
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Prism spectacles
Fresnel or ground-in prisms to neutralise small-angle diplopia.
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Orthoptic exercises
Structured exercises for convergence insufficiency and binocular retraining.
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Botulinum toxin for cranial nerve palsy
Chemodenervation of the antagonist muscle to reduce diplopia while recovery is awaited.
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Squint surgery
Extraocular muscle surgery planned from prism cover measurements.
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Neurology referral for underlying cause
Onward neurology for acquired palsies, myasthenia and demyelinating disease.
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Thyroid eye disease MDT
Joint orthoptic, ophthalmology and endocrine management of orbitopathy.
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Structured orthoptic follow-up
Serial visits to track response and re-plan management.
Red flags
When it isn’t a routine orthoptic problem.
These presentations need same-day ophthalmology, neurology or A&E — not a scheduled orthoptic slot.
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Third nerve palsy with pupillary involvement
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Sudden diplopia with neurological signs
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Post-stroke visual field defect
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Thyroid eye disease with optic nerve compression
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Idiopathic intracranial hypertension
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Myasthenia gravis (fatigable diplopia)
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Post-orbital fracture diplopia
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Post-cataract surgery amblyopia risk
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Sudden severe amblyopia in children
Frequently asked
Everything we get asked about orthoptic assessment.
Straight answers on what the assessment covers, who it’s for, and when urgent care is the right route instead.
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What is an orthoptic consultation?
A specialist assessment by an orthoptist of eye movement, alignment and binocular vision. It covers amblyopia, squint (strabismus), double vision (diplopia) and the impact of neurological or thyroid disease on the eye muscles.
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Who is an orthoptist?
An orthoptist is a regulated allied-health specialist in ocular motility and binocular vision, working alongside consultant ophthalmologists. Orthoptists lead diagnosis and non-surgical management of squint, amblyopia and diplopia.
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Does my child need an orthoptic assessment?
Yes if there is a suspected squint, a family history of amblyopia, a persistent head turn, or reduced vision picked up on a school-vision screen. Amblyopia is most treatable in early childhood.
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I have sudden double vision — what should I do?
Sudden-onset diplopia, especially with headache, pupil change or other neurology, needs urgent assessment — A&E rather than a private slot. A pupil-involving third nerve palsy is a neurosurgical emergency until an aneurysm has been excluded.
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What can be done for a squint in an adult?
Options include prism spectacles, orthoptic exercises, botulinum toxin and, in selected cases, extraocular muscle surgery. Management is planned from prism cover measurements taken in clinic.
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How long does an orthoptic consultation take?
A first assessment usually takes 45–60 minutes and includes visual acuity, cover testing, motility, stereopsis and prism cover measurements, with a written report and plan on the same day.
Sources and further reading
What we referenced.
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British and Irish Orthoptic Society. Standards and guidelines.
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Royal College of Ophthalmologists. Clinical guidelines.
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American Academy of Ophthalmology. Preferred Practice Patterns.
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European Strabismological Association.
Reviewed by Pulse Atlas Editorial Board, . Published 2026-07-30. Next review 2027-07-30.
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In practice, in London
What orthoptic consultation looks like on the ground in London
With orthoptic consultation, the London question is usually about report turnaround and the radiologist reading it — not whether the scan is available. The NHS route for orthoptic consultation is thorough, but the queue is real. Most patients we speak with have been told to expect anywhere from a handful of weeks to several months, depending on their local trust and how the referral is graded. Going private in London usually collapses that window to a matter of days — often the same week if the diary allows. It isn’t about jumping a queue so much as buying time back while you still have the flexibility to plan around it.
A typical private booking for orthoptic consultation in London starts with a consultant conversation — sometimes in person on Harley Street or Marylebone, sometimes on video if that suits better. Any imaging or diagnostics happen at a nearby CQC-registered facility, and reports usually land within 24 to 72 hours. The whole loop, from first call to written report, is often done inside a fortnight. For orthoptic consultation specifically, the difference between a routine report and a sub-speciality read is where private care earns its keep.
Where a good concierge earns its keep is in the matching. There are dozens of consultants in London who see orthoptic consultation — but not all of them are the right fit for every case. We narrow it down based on subspecialty, insurer coverage, the specific question being asked, and whether continuity into treatment matters. The right first appointment saves you from repeating yourself later.